Today we learnt just how long some people can be waiting for a physiotherapy appointment within the public hospital system. Our first patient of the day was suffering from anterior knee pain according to the referral for the last 2/52….this was in May. Therefore by the time he was passed onto us he was now at 24/52 and unsurprisingly did not turn up. This made me aware that by the time some patients see us they can be quite frustrated at how long it has taken and possibly also in a worse state than when the referring doctor saw them, therefore it is wise to take this into consideration when assessing a patient.
One of our patients today was returning following a conservatively managed partially ruptured Achilles tendon and a HEP we had prescribed to her. The last time we saw her she had only just had her plaster removed and we were a bit cautious with our treatment and exercises we gave her since she had not seen her doctor as yet and did not want to cause her any additional harm or damage. Our aim this time was to progress her exercises to eccentric movements and begin the realignment of the collagen fibres to make the tendon structurally stronger. This would need to be a balancing act between too much and too little progression. We made the patient aware that despite her not feeling too much pain there was still the chance that damage could be done and she’d be put back a few places in terms of recovery. She appeared to understand the situation.
We searched the depths of our knowledge from PHTY111 days and applied Deep Transverse Frictions to realign the fibres and effleurage to redistribute the swelling. The treatments appeared to be effective and the patient commented that the foot felt better. This treatment regime would be used again next time. Her HEP was progressed to involve some PWB exercises but we emphasized that she should not push it into pain and just a slight stretch should be felt.
Overall the patient appeared very pleased with her progress which showed to us that we had selected the correct treatment program and our clinical reasoning in terms of the speed of progressions was justified. We questioned her about more than the current Achilles problem and looked at her lifestyle and how she is modifying it to benefit her overall health & well being. She suffers from COPD and still smokes so we ensured that she was endeavouring to quit but obviously for a life long smoker this is going to be a long and hard road. She had modified her medication to decrease her reliance on them and begin a more “natural form of recovery”.
I look forward to seeing this patient again next week and discharging her with a continuing HEP to maintain her current recovery progress.
Thursday, October 30, 2008
Tuesday, October 28, 2008
Week 3.2 Entry
Almost half way and still getting along with my sidekick…who would have thought.
Once again even though we were referred this patient we weren’t completely sure of what was going on due to the ineligible nature of the doctors hand writing. We were aware of the patient’s presenting condition but beyond that we were clueless. Turned out the patient had 2 x THR approximately 2yrs ago which greatly affected our initial thoughts on what direction to take the assessment in. For example we wanted to determine if glut med was tight and playing a part in the discomfort the patient was feeling but the stretch required had the patient in F, and Add…big C/I for people with THRs. Another complication was that the patient experienced pain very easily which made assessment and subsequent treatment very difficult. The subjective part of the assessment was also long and time consuming but covered all major aspects. We were able to pin point where the Rx and HEP should be directed based on the patient’s concerns and the objective findings. The patient was revisiting the surgeon in 2/52 so we held back on progressing her too fast until the surgeon had an opportunity to assess her progress and complications.
We found difficulty working with the patient due to her sensitivity to mvts. We did not want to push her too far beyond her pain threshold since we could see that she was very apprehensive about troubling her hip. I suspect there may have been some exaggeration with regards to pain so that we did not test her too much. As to be expected during an initial consultation where everything is being assessed the patient’s primary issue becomes quite irritable making all further assessment and treatment at the time a bit more difficult. This was the case today and hopefully our next session will be a lot more targeted and streamlined towards the main problems. We have seen a quite a few THR and TKR patient’s and have started to build up a list of assessment objectives and exercises for the different stages of recovery. To make this knowledge second nature would make prescribing and progressing treatment more effective.
As I mentioned being able to target the session more next time will give me more confidence in what we have found out and that our intervention is progressing in the correct direction. A lack of information leaves holes in the findings and possible problems with the intervention. The patient needs to know throughout the whole process what is happening and be assured that they will be able to return to what they are limited in doing…..I need to make an extra special point of attempting to find out about the patient’s social history and showing an interest in helping them return.
I can imagine from a patient’s point of view they have already been to see Drs, surgeons, other physios and been through the whole assessment process many times before so that, to certain extent, expect all follow up professionals to know exactly where they are at and what the main issues are and how things should progress. This is very much not the case! For this reason the subjective questioning needs to be targeted and succinct but still be able to gain a clear picture of what we are dealing with. I feel that I have developed this over time by not spending excessive amounts of effort on enquiring about information that will in effect not be a major factor in the intervention thus making the entire process as simple and straight forward as possible for the patient.
Once again even though we were referred this patient we weren’t completely sure of what was going on due to the ineligible nature of the doctors hand writing. We were aware of the patient’s presenting condition but beyond that we were clueless. Turned out the patient had 2 x THR approximately 2yrs ago which greatly affected our initial thoughts on what direction to take the assessment in. For example we wanted to determine if glut med was tight and playing a part in the discomfort the patient was feeling but the stretch required had the patient in F, and Add…big C/I for people with THRs. Another complication was that the patient experienced pain very easily which made assessment and subsequent treatment very difficult. The subjective part of the assessment was also long and time consuming but covered all major aspects. We were able to pin point where the Rx and HEP should be directed based on the patient’s concerns and the objective findings. The patient was revisiting the surgeon in 2/52 so we held back on progressing her too fast until the surgeon had an opportunity to assess her progress and complications.
We found difficulty working with the patient due to her sensitivity to mvts. We did not want to push her too far beyond her pain threshold since we could see that she was very apprehensive about troubling her hip. I suspect there may have been some exaggeration with regards to pain so that we did not test her too much. As to be expected during an initial consultation where everything is being assessed the patient’s primary issue becomes quite irritable making all further assessment and treatment at the time a bit more difficult. This was the case today and hopefully our next session will be a lot more targeted and streamlined towards the main problems. We have seen a quite a few THR and TKR patient’s and have started to build up a list of assessment objectives and exercises for the different stages of recovery. To make this knowledge second nature would make prescribing and progressing treatment more effective.
As I mentioned being able to target the session more next time will give me more confidence in what we have found out and that our intervention is progressing in the correct direction. A lack of information leaves holes in the findings and possible problems with the intervention. The patient needs to know throughout the whole process what is happening and be assured that they will be able to return to what they are limited in doing…..I need to make an extra special point of attempting to find out about the patient’s social history and showing an interest in helping them return.
I can imagine from a patient’s point of view they have already been to see Drs, surgeons, other physios and been through the whole assessment process many times before so that, to certain extent, expect all follow up professionals to know exactly where they are at and what the main issues are and how things should progress. This is very much not the case! For this reason the subjective questioning needs to be targeted and succinct but still be able to gain a clear picture of what we are dealing with. I feel that I have developed this over time by not spending excessive amounts of effort on enquiring about information that will in effect not be a major factor in the intervention thus making the entire process as simple and straight forward as possible for the patient.
Thursday, October 23, 2008
Week 2.3 Entry
After our last experience of someone with “just knee pain” we were a bit more prepared for a few more possible scenarios. Would be great if the referring doctors could put down a bit more detail on the patients they are sending our way but I’m sure I’ll be waiting along time for that miracle to happen. The patient had injured her L knee from overuse approximately 9/52 ago without a single specific incident causing the pain. She had surgery 10/12 ago on the same knee to clean out debris and lose cartilage but had suffered no further pain after this which was interesting considering the period between that and her current pain. From the outset we could sense that this patient was impressed with her own ability to withstand pain and exaggerate the pain experience. This made it somewhat difficult at times to decipher exactly what the extent of pain was and how it was actually limiting her and what it meant in the scheme of things. Once again I learnt that even though you may ask about every possible joint and issue the patient will still miss fairly significant pieces of information. In this case she had dislocated her right patella twice with no further complications but this then lead to us learning that there is a family history of unstable patellas and this could be contributing to the current problem in her left leg. Maybe we should make an extra special point of clearing all possible problems with the contralateral side.
The patients sensitivity to movements meant she had only approximately 20° of mvt (could not be moved passively). Strength could not be measured as a result and no other special tests were possible. Despite all this we agreed that the most important course of action was improve the ROM. We were not to sure as to whether we should be pushing her beyond her pain limits (10/10 at EOR) but our supervisor realised that no further damage was going to be done and increasing her ROM was paramount. I have realised that there is a certain amount of bullying of patients that needs to be done to get results but only when it’s safe and within limits. This requires a great amount of trust in the PT by the patient.
It was important to make it very clear to the patient that the sooner we can get her to full function the sooner she could return to work and this means a lot of hard work and most likely an amount of pain. We need to make her aware that pushing beyond the pain will be required sometimes but this will still need to be monitored closely as it could get to a point where additional damage is being caused. With other patients I will push them a bit more beyond their initial pain to enable a better assessment and treatment result.
The patients sensitivity to movements meant she had only approximately 20° of mvt (could not be moved passively). Strength could not be measured as a result and no other special tests were possible. Despite all this we agreed that the most important course of action was improve the ROM. We were not to sure as to whether we should be pushing her beyond her pain limits (10/10 at EOR) but our supervisor realised that no further damage was going to be done and increasing her ROM was paramount. I have realised that there is a certain amount of bullying of patients that needs to be done to get results but only when it’s safe and within limits. This requires a great amount of trust in the PT by the patient.
It was important to make it very clear to the patient that the sooner we can get her to full function the sooner she could return to work and this means a lot of hard work and most likely an amount of pain. We need to make her aware that pushing beyond the pain will be required sometimes but this will still need to be monitored closely as it could get to a point where additional damage is being caused. With other patients I will push them a bit more beyond their initial pain to enable a better assessment and treatment result.
Week 2.2 Entry
Myself and Bec experienced what will probably happen many more times in our careers as physios….we doubled booked. This worked out well for us though given that both were returning patients and the assessment aspect wasn’t as in depth as the first time and it also gave both of us an opportunity to run through the whole assessment process individually. My patient was returning after a bilateral calcaneal fracture 9/52 ago. He was progressing well, the swelling and pain had decreased and his ankle ROM (esp. DF) had increased. He had been completing his daily exercises which was great to hear considering his past history of not following physiotherapist prescribed exercises. He was very happy with his progression and still showed eagerness to get back to work asap. I was a bit unsure as to how I should progress his treatment and exercises given that the injury was a fracture and did not want to have him weight bearing excessively even though he progressed well and he was managing the original exercises easily. The main factor still was to improve his ROM within pain limits which was fairly easy given that he was very tolerant to pain. I carried out passive physiological DF with a slightly increased amount of force to EOR, this marginally improved the ROM and will possibly progress this to a Gr4 pass phys mobilization next time. I maintained the same exercise program but increased the resistance of the theraband which he managed very well.
The patient was revisiting the surgeon (ORIF on R calcaneus) in 3 weeks so I was a bit cautious about progressing treatment and exercises too soon before we had confirmation that the fractures had healed sufficiently enough. I will need to look into acceptable progressions for his current situation (PTs. Internet etc). The assessment process is very relaxed with this individual and I felt I clearly explained everything and if he had any questions he would be happy to ask. Forward planning for all possible outcomes is important and as we develop our skills this will come more and more easily but at the moment every possibility needs to be thought through. I was very pleased with how everything progressed and I look forward to seeing him next time.
The patient was revisiting the surgeon (ORIF on R calcaneus) in 3 weeks so I was a bit cautious about progressing treatment and exercises too soon before we had confirmation that the fractures had healed sufficiently enough. I will need to look into acceptable progressions for his current situation (PTs. Internet etc). The assessment process is very relaxed with this individual and I felt I clearly explained everything and if he had any questions he would be happy to ask. Forward planning for all possible outcomes is important and as we develop our skills this will come more and more easily but at the moment every possibility needs to be thought through. I was very pleased with how everything progressed and I look forward to seeing him next time.
Tuesday, October 21, 2008
Week 2.1 Entry
Upon initial thoughts of the referral letter and documentation this appeared to be another basic case of PFJ pain syndrome and Bec and I were expecting a fairly straight forward assessment…how wrong we were. The individual was a heavy set man, which apart from being a contributing factor for knee pain may also be a factor to consider for several other problems and health issues such as diabetes, hypertension, heel and hip pain and a herniated disc. The history taking was a long process as new issues were constantly being raised as we proceeded. I imagine as our experience builds we will streamline similar cases a lot more but at this point in time we covered every possible angle and still could have asked other questions. Despite all the other issues that were made apparent our main concern, as was pointed out by our supervisor was the knee pain as this was the most debilitating of the conditions and essentially why he was referred on. This was also reiterated as the main issue in the patient’s mind despite the fact that he didn’t show much frustration with how the issue was limiting him which was even more surprising given that he mentioned he had a suffered from depression only 2 years ago. The patient was very easy to communicate with but had to be kept on course repeatedly since the extensive nature of the questioning did not allow for long dialogues on every part of the subjective assessment. The objective part of the assessment was straight forward with the main emphasis being on his patella alignment and the issues associated with this.
With all the issues discovered it would have been easy to be startled with the extent of information given and what do to do with it all. We managed to take everything into account but still focus on the main problem at hand. With a few more patients like this we will learn to target out assessment towards the main problem but at the same time ensure that all areas are covered in case important information is presented. My filling in of the assessment form will need to be improved; with all the information my note taking was a bit scattered and may be hard to decipher by the next physio. Also taking note of the times of the onset of pains will need more attention. As mentioned the patient was a large man and next time I would like to suggest to him in the nicest possible way that losing some weight will go a long way towards reducing his pain. I very subtly mentioned this during this assessment, that he should “Try to attempt any form of exercise within his pain limitations…” Coming up with ideas for progressing his exercise program is required.
I was happy with how the assessment progressed and felt that the patient was comfortable with us. We worked through each aspect of the assessment smoothly and covered each aspect systematically, enabling us to gain a clear picture of what his problems were and how/if they were linked. Our understanding and subsequent explanations of his conditions appeared to make the patient pleased with our we were moving forward. Streamlining the process more and being systematic about the analysis of each condition would make the assessment process more efficient and effective. Ensure that we mention every joint that could be painful and ensuring the patient knows that we want everything and anything that has happened to them in the past to build up a clear full history.
The patient mentioned that he suffered from sleep apnoea. I will look into the details of this condition since he was using a face mask to help him breath during sleep. This has no bearing on his condition or recovery but would be good to know what it’s all about for next time we see him since it is appeared to be a major issue for him.
With all the issues discovered it would have been easy to be startled with the extent of information given and what do to do with it all. We managed to take everything into account but still focus on the main problem at hand. With a few more patients like this we will learn to target out assessment towards the main problem but at the same time ensure that all areas are covered in case important information is presented. My filling in of the assessment form will need to be improved; with all the information my note taking was a bit scattered and may be hard to decipher by the next physio. Also taking note of the times of the onset of pains will need more attention. As mentioned the patient was a large man and next time I would like to suggest to him in the nicest possible way that losing some weight will go a long way towards reducing his pain. I very subtly mentioned this during this assessment, that he should “Try to attempt any form of exercise within his pain limitations…” Coming up with ideas for progressing his exercise program is required.
I was happy with how the assessment progressed and felt that the patient was comfortable with us. We worked through each aspect of the assessment smoothly and covered each aspect systematically, enabling us to gain a clear picture of what his problems were and how/if they were linked. Our understanding and subsequent explanations of his conditions appeared to make the patient pleased with our we were moving forward. Streamlining the process more and being systematic about the analysis of each condition would make the assessment process more efficient and effective. Ensure that we mention every joint that could be painful and ensuring the patient knows that we want everything and anything that has happened to them in the past to build up a clear full history.
The patient mentioned that he suffered from sleep apnoea. I will look into the details of this condition since he was using a face mask to help him breath during sleep. This has no bearing on his condition or recovery but would be good to know what it’s all about for next time we see him since it is appeared to be a major issue for him.
Thursday, October 16, 2008
Week 1.3 Entry
Today WE had our first truly undiagnosed patient which made us work a lot harder in our assessment. She was referred to us by a doctor who suggested some early degenerative changes which only presented as ant-med knee pain. We quickly determined that the pain was a lot more diffuse and covering more than the area stated (which was another occasion where the referral letter should not be taken as gospel and our own assessment should guide our diagnosis). The widespread nature of the pain required us to perform all possible tests of the knee (PHTY211 revision stat!). It was obvious that the patient had a lot on her plate in terms of work and children and was very keen to start on the road to rescovery. The patient was very responsive and helpful with all questioning and assessing, possibly even too helpful. The Hawthorn effect may have been in play to a small extent when we attempted to relieve her pain with a medial glide of the patella during a squat….she knew we expected a decrease in pain. Maybe something to keep an eye on for next time. Our supervisor suggested the use of a squat as a quick test first up and then reassess at the end of the session. This enabled us to witness clearly how the patient compensated and just how restricted she was.
All special tests were negative except for assessment of the patella which reduced pain when it was glided medially which indicated some form of patella alignment dysfunction and this guided our treatment. When I performed the special tests I had not planned the progression of the tests very well which lead to repeated movement of the patient throughout the session. Not a major issue but can be frustrating and time consuming for the patient especially with the amount of tests possible on the knee. Despite this I was happy with not only the fact that I remembered the majority of the tests but did them correctly. I felt that we explained clearly to the patient what all the tests were for and that it’s all part of a standard assessment and there was no cause for concern. Next time we see this patient we have already done the majority of the tests and we can streamline the assessment further and progress her exercises and determine her improvements.
Due to the unknown nature of the pain we were left to hunt for answers a bit more which had us thinking through all the information and trying to piece it together. With some guidance from our supervisor we managed to point ourselves in the right direction and eliminate many possible causes. As we progressed through my confidence grew in what we were doing. Next time I would set out clearly the plan for the session and make it a lot smoother and think about what all the information means in the overall scheme of things.
We will need to determine a greater amount of exercise options and make sure they are kept interesting since we heavily rely on the patient to effectively carry out their HEP. Overall we progressed through the session very well and despite the unusual nature of the pain experience we were happy with our eventual diagnosis and look forward to next time to further analyse our clinical reasoning. To enable her to function more effectively for the short term we taped her patella medially to relieve pain and show her that our treatment plan was in the right direction to resolve her problem.
Patella-femoral pain syndrome is very common and the treatment is fairly standard so a look into a more diverse range of exercises and treatments would be worthwhile.
All special tests were negative except for assessment of the patella which reduced pain when it was glided medially which indicated some form of patella alignment dysfunction and this guided our treatment. When I performed the special tests I had not planned the progression of the tests very well which lead to repeated movement of the patient throughout the session. Not a major issue but can be frustrating and time consuming for the patient especially with the amount of tests possible on the knee. Despite this I was happy with not only the fact that I remembered the majority of the tests but did them correctly. I felt that we explained clearly to the patient what all the tests were for and that it’s all part of a standard assessment and there was no cause for concern. Next time we see this patient we have already done the majority of the tests and we can streamline the assessment further and progress her exercises and determine her improvements.
Due to the unknown nature of the pain we were left to hunt for answers a bit more which had us thinking through all the information and trying to piece it together. With some guidance from our supervisor we managed to point ourselves in the right direction and eliminate many possible causes. As we progressed through my confidence grew in what we were doing. Next time I would set out clearly the plan for the session and make it a lot smoother and think about what all the information means in the overall scheme of things.
We will need to determine a greater amount of exercise options and make sure they are kept interesting since we heavily rely on the patient to effectively carry out their HEP. Overall we progressed through the session very well and despite the unusual nature of the pain experience we were happy with our eventual diagnosis and look forward to next time to further analyse our clinical reasoning. To enable her to function more effectively for the short term we taped her patella medially to relieve pain and show her that our treatment plan was in the right direction to resolve her problem.
Patella-femoral pain syndrome is very common and the treatment is fairly standard so a look into a more diverse range of exercises and treatments would be worthwhile.
Wednesday, October 15, 2008
Week 1.2 Entry
I was presented with a gentleman who had sustained a bilateral calcaneal fracture. I was made aware of the nature of his injury the day before his visit so I was able to prepare for a condition which I had no previous knowledge of. My first thoughts were that this was a very debilitating injury due to his limited WB ability and the fact that it was bilateral….where would I start from a physiotherapy point of view?
This injury greatly affected his life in that he was self employed and unable to work, his social life was now non existent and this was compounded by the fact that he lived alone and was forced to fend for himself every day. Essentially he needed to improve to full functionality as soon as possible and he was very eager to make this happen. The treatment and HEP were designed to reduce pain, improve ROM of his ankles and begin the long process of his return to work. I made it very clear to him that he needed to regain full movement of his LLs not only to walk but to effectively work again due to its physical nature, he seemed to understand this point. I ensured that his pain levels were kept within safe levels during treatment despite his ability to put up with a great deal of pain before stopping, this restricted what type of intervention that could be performed. The treatment chosen however did increase his ROM and with the HEP given to him this should improve again when he returns next week.
The patient was very easy to communicate with and was very open with his communication. Next time I would make a point of clearing each and every joint since despite asking if he had any problems elsewhere now or in the past it only came out by chance that he had badly broken his finger some years ago and had not followed the physio program and now had a reduced function in this finger. This highlighted to me that I needed to make a special effort to ensure he understood the implications of not following a physio program with his current problem. I also neglected to pay attention to his function at his knees and hips which were important areas due to his decreased activity and de-conditioning. Even though not directly involved in the injury needed to be looked at as they would affect his walking when the time came. I have already planned to progress his HEP depending on his progress and also reassess all objective measures and possibly increase the grade of the mobilizations performed.
I was very comfortable throughout the process and felt that I had a clear grasp on the main issues and patient concerns. Next time I would gain a more complete and thorough history of the patient and remember that it’s better to have too much information rather than too little. Post treatment assessment is crucial, not only for me but for the next physio that may be treating. I felt that I have progressed today and continued to develop my assessment and treatment aptitude by understanding more so the importance of each aspect of the questioning. Not just asking questions for the sake of asking the question but realising where the information may lead my thinking and where it will guide my treatment.
One thing I would like to know is about the muscle strength scale that we have been shown on placement. It is similar to the Oxford scale but takes into account the range of motion of the joint not only the strength. Without going into too much detail it basically goes 0, 1, 1+……4, 4+, 5. I was not able to find any information on the internet but would like to know since I believe it would be much more useful than Oxford scale.
This injury greatly affected his life in that he was self employed and unable to work, his social life was now non existent and this was compounded by the fact that he lived alone and was forced to fend for himself every day. Essentially he needed to improve to full functionality as soon as possible and he was very eager to make this happen. The treatment and HEP were designed to reduce pain, improve ROM of his ankles and begin the long process of his return to work. I made it very clear to him that he needed to regain full movement of his LLs not only to walk but to effectively work again due to its physical nature, he seemed to understand this point. I ensured that his pain levels were kept within safe levels during treatment despite his ability to put up with a great deal of pain before stopping, this restricted what type of intervention that could be performed. The treatment chosen however did increase his ROM and with the HEP given to him this should improve again when he returns next week.
The patient was very easy to communicate with and was very open with his communication. Next time I would make a point of clearing each and every joint since despite asking if he had any problems elsewhere now or in the past it only came out by chance that he had badly broken his finger some years ago and had not followed the physio program and now had a reduced function in this finger. This highlighted to me that I needed to make a special effort to ensure he understood the implications of not following a physio program with his current problem. I also neglected to pay attention to his function at his knees and hips which were important areas due to his decreased activity and de-conditioning. Even though not directly involved in the injury needed to be looked at as they would affect his walking when the time came. I have already planned to progress his HEP depending on his progress and also reassess all objective measures and possibly increase the grade of the mobilizations performed.
I was very comfortable throughout the process and felt that I had a clear grasp on the main issues and patient concerns. Next time I would gain a more complete and thorough history of the patient and remember that it’s better to have too much information rather than too little. Post treatment assessment is crucial, not only for me but for the next physio that may be treating. I felt that I have progressed today and continued to develop my assessment and treatment aptitude by understanding more so the importance of each aspect of the questioning. Not just asking questions for the sake of asking the question but realising where the information may lead my thinking and where it will guide my treatment.
One thing I would like to know is about the muscle strength scale that we have been shown on placement. It is similar to the Oxford scale but takes into account the range of motion of the joint not only the strength. Without going into too much detail it basically goes 0, 1, 1+……4, 4+, 5. I was not able to find any information on the internet but would like to know since I believe it would be much more useful than Oxford scale.
Tuesday, October 14, 2008
Week 1.1 Entry
The first patient of my placement presented with bilateral OA of the ankles after being referred to the Swan Districts Hospital outpatients dept by an orthopaedic surgeon. I was not very aware of the specifics of assessment and treatment of OA initially so prepared with a brief literature review prior to seeing the patient. I used too many leading questions initially as was pointed out by my supervisor so worked on adjusting my questioning so that the patient’s responses were not being influenced by my questioning technique (more open or closed questions). Reducing pain and improving/maintaining ROM were the keys points to focus on throughout the assessment and treatment. The intervention I chose produced a very positive response from the patient and his eagerness to improve his situation was a great feeling at the end of the session. I explained the situation to him and he understood what our intervention was attempting to achieve. There were a few questions that I left out that were required to clarify his social history and some of my objective measures required a bit of fine tuning.
From the start I was very comfortable with the situation (helped having such a great patient) since I had a fair idea where I was headed with the session. As mentioned next time I would not ask as many leading questions and cover all possible previous problems since some issues that affected the intervention were not mentioned initially by the patient. I would also explain a bit more clearly what his actual problem was and how it would have progressed over time. I also need to work on filling out an assessment form more effectively.
I feel that things went very well, especially for a first day but I realise I have a lot of things to look at. We were given a couple of interesting cases and a fair bit of autonomy but still with good input and monitoring from my supervisor. For every case so far I have had to look through some literature and past/current unit’s material for information and ideas (wikipedia has also served me well).
From the start I was very comfortable with the situation (helped having such a great patient) since I had a fair idea where I was headed with the session. As mentioned next time I would not ask as many leading questions and cover all possible previous problems since some issues that affected the intervention were not mentioned initially by the patient. I would also explain a bit more clearly what his actual problem was and how it would have progressed over time. I also need to work on filling out an assessment form more effectively.
I feel that things went very well, especially for a first day but I realise I have a lot of things to look at. We were given a couple of interesting cases and a fair bit of autonomy but still with good input and monitoring from my supervisor. For every case so far I have had to look through some literature and past/current unit’s material for information and ideas (wikipedia has also served me well).
Sunday, October 12, 2008
Pre Placement
I probably have very similar feelings to everyone else in that I have a mix of nervousness but at the same time very keen to get out there and see what this physiotherapy business is all about. I know from my first time at uni I learnt so much from time spent out in the real world during work experience and I expect this first taste to be exactly the same if not even more beneficial. It will be very exciting to consolidate and apply everything we have learned up to this point and also learn much more. Five weeks seems like a long time but I’m expecting it to fly by.
Swan Districts hospital contains a very wide array of health professionals and it is crucial for effective communication with all. Physios must be willing to work together to enable a great amount of different experiences to be taken into account when assessing and treating patients. The physiotherapist must also be aware when expertise from outside the physio department is necessary and be able to organise the required resources on these occasions. To effectively manage a multidisciplinary team all parties need to be aware of the advantages of having different health professionals involved and also what each is able to bring to the group….an open mind is paramount.
Swan Districts hospital contains a very wide array of health professionals and it is crucial for effective communication with all. Physios must be willing to work together to enable a great amount of different experiences to be taken into account when assessing and treating patients. The physiotherapist must also be aware when expertise from outside the physio department is necessary and be able to organise the required resources on these occasions. To effectively manage a multidisciplinary team all parties need to be aware of the advantages of having different health professionals involved and also what each is able to bring to the group….an open mind is paramount.
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